Assessment of the expediency of pre-induction of labor at various stages of full-term pregnancy (a systematic review and meta-analysis)

Objective. To assess the expediency of pre-induction/ induction of labor during term physiological pregnancy of 37—40 weeks compared with the use of expectant tactics in patients with an immature cervix. Materials and methods. A systematic search and selection of randomized controlled trials (RCTs) (2000-2025) was performed in the PubMed, eLibrary, and Google Scholar databases, which included examinations of pregnant women with a gestation period of 37 weeks or more with a singleton cephalic pregnancy and immature cervix. An assessment of the risk of systematic errors and a meta-analysis were carried out (RevMan 5.4) with the calculation of relative risk (RR) and 95% confidence intervals (CI). Results. The review included three RCTs, which included more than 600 pregnant women. According to the results of the meta-analysis, the frequency of cesarean sections did not differ with the strategy of early pre-induction/induction of labor compared with the wait-and-see approach. There were no differences in the frequency of chorioamnionitis (1 RCT), the frequency of neonatal ICU hospitalization (2 RCTs), as well as the frequency of respiratory distress syndrome and ICU stay for more than 48 hours (1 RCT). Conclusion. There is no evidence of the benefits of starting pre-induction/induction of labor during a pre-normal pregnancy of 37—40 weeks in women with an immature cervix; in the absence of medical indications, pre-induction should be considered no earlier than 41 weeks of pregnancy. Additional RCTs are needed to increase the accuracy of estimates and analyze subgroups in which the clinical effect may be more pronounced.